I. Definition
Attention deficit hyperactivity disorder (ADHD), also known as pediatric hyperactivity disorder, is the most prevalent psychological behavior disorder during childhood and adolescence, which is characterized by attention deficit, hyperactivity-based behavior disorder and impulsivity, with basically normal intelligence but learning difficulties, motor function incoordination and psychological abnormalities. If children diagnosed with ADHD are not treated as early as possible, they may develop personality disorders and even anti-social behaviors such as delinquency in adulthood, which may have a wide and negative impact on their academic, professional and social life.
II. Etiology
The causes of ADHD are not well understood, but there are many factors that lead to ADHD in children, which can be broadly classified into four categories: genetic factors, toxic factors, environmental factors, and nutritional factors. Various complex biological factors and social environment lead to abnormal metabolism of neuromediators in the brain, the effective concentration of neuromediators is not enough, affecting the transmission of information, so that it is difficult to self-control.
1, genetic factors As the pediatrician develops bad habits during maternal pregnancy, with smoking and alcohol abuse, which affects the fetus. Or the pediatrician’s blood siblings suffer from ADHD, which can also affect the cause of ADHD.
2, poisoning factors Chemical substances (such as lead) poisoning can bring serious physical harm to children, children are still young, the body’s immune system is fragile, poisoning is easy to harm the nervous system, so that children become demented and so on. There is a lot of evidence to confirm that environmental pollution caused by various physical and chemical factors can lead to behavioral changes in children.
3, social and family psychological environment factors Children live in poor environmental and family conditions, such as broken families, economic poverty, overcrowded housing, parental divorce, alcoholism, etc.
4, diet and nutrition factors Children lack the nutrients needed by the body, vitamin intake and mineral intake is insufficient.
So that their own body quality is reduced, can not resist the invasion of foreign viruses, low immunity. Or children’s excessive high sugar diet, food added coloring or flavoring, preservatives, all may cause ADHD.
5, other factors In the past 20 years, pediatric experts have unexpectedly found a close relationship between rotational subluxation of the cardinal vertebrae and ADHD in children. After treatment with manual repositioning, clinical symptoms were all significantly improved or disappeared, probably due to the rotational subluxation of the cardinal vertebrae, resulting in insufficient blood supply to the vertebrobasilar artery, affecting the blood supply to the brain, brainstem and other structures, and causing ischemia in the main centers that manage language, learning, memory, emotion and other functions.
Children with obstructive sleep apnea syndrome have behavioral problems of attention-deficit/hyperactivity disorder that are reversible, and adenoidectomy and/or tonsillectomy can help improve the attention-deficit/hyperactivity disorder.
III. Diagnosis
The clinical manifestations of children with ADHD are as follows.
1, attention disorder: manifested as age-inappropriate inattention, children with the disease significantly reduced attention, lose interest in things around them, like to look around, can not completely focus on one place, even if stimulated by the sound will not speak attention to shift over. For children who are attending school, the performance in the classroom becomes more obvious, mainly in terms of inattentive listening, absent-mindedness, lack of concentration of thought, etc.
2, excessive activity: manifested as too much action inappropriate with age and environment, the amount of child activity than before greatly increased. Along with age, the habit of hyperactivity and mobility still exists. Children are fidgety and often move unconsciously just after sitting or just after standing. Children who go to school have frequent small movements in the classroom and jump around when walking, all of which are caused by ADHD.
3, perceptual disorders: manifested as the ability to feel things, the ability to discriminate, thinking ability are significantly reduced. At this time, children often make mistakes in daily life and are unable to accurately analyze and discriminate things, such as: not being able to move normally, unclear spatial concepts, unclear analysis of things, lack of intuition for sound, pain and other strong sensory, etc.
4. Emotional disorders: Children with ADHD are emotionally unstable and will become impulsive when slightly stimulated by external stimuli, sometimes dancing with excitement, sometimes crying and throwing tantrums, and being unpredictable. Children who go to school will often argue or fight with their classmates, and when they encounter something they cannot think through and solve it, they will do whatever they want, causing obstacles not only to their own behavior, but also to the people around them.
5. Maladjustment: At this time, children are stubborn and adore individualism. Unable to adapt to a large number of people living and learning environment, do not want to stay with other children of the same age, so it is difficult to get along with other children of the same age. This symptom can easily cause the child’s personality isolated, after growing up in the psychological can not integrate into society, behavior also can not do according to the rules, and is very likely to cause a bad impact.
6, learning difficulties: Although the children with ADHD can basically maintain normal intelligence, but due to the existence of heavy ability barriers, making their academic performance is often much worse than normal children. Because of the classroom can not listen carefully, resulting in learning efficiency is greatly reduced, which is the main reason for learning difficulties. In particular, learning the knowledge of science classes, the lack of calculation, thinking and other aspects of the ability to cause considerable learning difficulties
7, fine and coordinated movement difficulties: children with ADHD have clumsy movements, such as tying buttons, tying shoelaces, inflexible pencil sharpening movements, walking in a straight line, etc.
8, neurological signs: ADHD children commonly show positive finger-nose test, rapid finger test, alternating test, hand-turning test, etc.
The diagnosis of pediatric ADHD is based on the above medical history and physical examination provided by the parents and teachers of the child, and the following criteria are met.
(1) Age at least 6 years old.
(2) The main symptoms appear before the age of 7 and last for more than 6 months.
(3) The child has normal or near normal intelligence.
IV. Treatment
There are many treatment methods for ADHD, such as medication, psycho-behavioral therapy, Chinese medicine, physical therapy, etc. In the past, due to various misunderstandings about the treatment of the disease, especially the fear of side effects of drugs, compliance is not high, many children did not receive appropriate treatment, delaying the treatment time. In recent years, it has been found that only pharmacological and non-pharmacological treatment can be carried out simultaneously to maximize the effect, while the effect of non-pharmacological treatment alone is often not satisfactory.
1.Pharmacological treatment
Drug treatment options are many. The central nervous system stimulant methylphenidate hydrochloride is still the drug of choice for the treatment of ADHD, especially the long-acting controlled-release tablets (such as Concentrate) has the advantages of good effect, long maintenance time, and small adverse reactions, and has been gradually recommended by treatment guidelines as the drug of choice for the treatment of ADHD. Other drugs for ADHD have also been gradually used in clinical practice, such as antidepressants, antipsychotic agents, antiepileptic agents, and norepinephrine reuptake inhibitors, which provide more drug options for ADHD patients.
Because the symptoms of ADHD are long-lasting, the effects on children with ADHD are also long-lasting, and medication needs to be taken for a long time. It is unscientific to use an intermittent treatment approach to medication. If intermittent treatment is used, the symptoms may improve when learning, but other aspects of the problem do not improve, while in fact children’s behavior and various functional problems, is a more important issue than academic performance.
2.Psychotherapy
The main way to strengthen the control of the child’s physical habits is through training, and gradually develop the child’s habits of life. Psychotherapy can also be carried out to control the child’s mind so that he can focus his energy in one place. The main measures are self-control training, relaxation training and comprehensive therapy.
a. Self-control training: mainly through some simple, fixed verbal commands so that the child can control his or her own behavior ability. The training needs to be carried out in several aspects, such as listening, speaking, reading, writing and walking. For example, in learning, a simple question for the child to answer and calculate, requiring the child to follow the steps; or in the process of the game to exercise the child’s running ability, to develop their reaction speed.
b. Relaxation training: Parents can take some relaxation measures in daily life to relieve the child’s nervous state of mind and face life with a positive mood, which will help the doctor to implement treatment. The relaxation method is currently a new method of treating pediatric
ADHD is a new method of treatment. In the treatment process, you can relax your child’s mind step by step by playing games, music and stories.
c. Integrated therapy: Integrated therapy is a combination of several therapies used in conjunction with each other, according to the degree of the child’s condition, the reasonable adjustment of the treatment method after the integrated use.
Doctors and parents also need to educate the child mentally and spiritually. When a child’s behavior is found to be undesirable, the child should be stopped in time and then educated to guide the child in the right direction. ADHD has a great impact on the healthy growth of children, so it needs to be treated as soon as possible.
3, Chinese medicine treatment
Traditional Chinese medicine (TCM) locates ADHD in the imbalance of the liver, kidney, heart and other internal organs and the imbalance of yin and yang, and through traditional Chinese medicine, acupuncture, massage and other means to adjust the yin and yang, calm the mind and calm the fear. It has played an active role in the clinical treatment of ADHD, with precise efficacy and few side effects, making up for the shortcomings of Western medicine. Some of them even have the power to start the disease. Some proprietary Chinese medicines such as Jingling Oral Liquid have also been successfully promoted for clinical application.
4.Physical therapy
At present, there are also many scholars using EEG biofeedback methods and new physical therapy means transcranial magnetic field therapy to treat ADHD, clinical reports are more satisfactory. In recent years, our department practice the application of transcranial magnetic therapy with the above-mentioned Chinese and Western medicine means to treat ADHD, the efficacy is indeed more objective.
V. Family rehabilitation
1.Preventive measures
Pre-marital examination, avoid inbreeding, spouse selection, try to pay attention to the presence of epilepsy, schizophrenia and other psychiatric disorders.
Marry at an appropriate age, do not marry early, early pregnancy, and do not marry too late, late pregnancy, to avoid congenital deficiencies of the baby.
In order to avoid birth injuries and reduce the possibility of brain damage, natural and normal delivery should be tried as much as possible, because it is found in the clinic that a higher percentage of children with ADHD are delivered by caesarean section. Pregnant women should pay attention to temperament, keep a happy mood, mental peace, avoid cold and heat, prevent diseases, and use drugs carefully.
Create a warm and harmonious family life environment, so that the child can spend his childhood in a relaxed and happy mood, do not blindly hope that the child will become a dragon, depriving the child of a happy childhood, causing unnecessary mental trauma.
Pay attention to reasonable nutrition. Make the child develop good eating habits, not partial food, not picky food, to ensure adequate sleep. Strengthen physical exercise to enhance physical fitness and prevent the occurrence of diseases.
Try to avoid letting children play with toys containing lead paint, especially not to hold such toys in the mouth.
2.How to care for children with ADHD
Parents and teachers should understand that children with ADHD do not do it on purpose, create a quiet and relaxed environment for them, and guide them properly. Such as manual training, drawing, role-playing, self-praise and other methods to improve and correct the child’s behavior problems. Stabilize the child’s emotion and patiently guide the child to do everything well. If the child is impatient, give proper guidance, don’t provoke the child, let him/her finish a task when conditions allow, and give rewards.
Arrange somatic training programs Such as arranging aerobics, swimming, chess and other activities to develop the child’s patience, control impulses and improve behavior, and enhance self-control.
Cultivate the social adaptation ability of the child Let the child have more contact with sympathetic children, experience the emotional experience of normal children, improve social interaction skills and correct their bad behavior.
Special training methods for children with learning difficulties and the necessary vocational counseling and training to enable them to fully explore their potential and thus improve their academic performance.
3.Children’s ADHD food therapy
According to the research, the lead content in pediatric ADHD patients is generally high, and it is often accompanied by the weakness of the internal organs. Avoid stimulating drinks and foods such as chili, fatty meat, garlic, instant noodles, grilled lamb skewers, etc.
There are still many issues that need to be addressed in the treatment of ADHD, such as the efficacy of various treatments for different ADHD subtypes, the long-term efficacy of each approach, the efficacy of different combinations of approaches, new approaches to the treatment of comorbidities, and the formation of a flow chart for the final treatment. Thus, medical practitioners are still exploring the treatment of ADHD in children.
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